The comments by Spada et al. (which are similar in style and content to the ones already made by the authors on the Italian Ministry of Health Web site) are based on misunderstandings and manipulations. The essence of systematic reviews is to sum up available knowledge and minimize bias. The latter is done by a priori stating study inclusion criteria both in the protocol and in the full HTA report (see Fig. 1, p. 299) and assessing methodological quality of included studies using an instrument which was specified in the protocol text and never changed (the Quality Assessment Diagnostic Accuracy Studies checklist or QUADAS). The purpose of inclusion criteria and bias minimization efforts is to ensure that what is included in a review is both relevant and contributes evidence weighted by its reliability to answer the study question (in our case the diagnostic performance of WCE in the small bowel). The high number of excluded studies is thus irrelevant, although it is a common feature of systematic reviews. What matters is what the included studies tell us.

Objectives: The aim of this study was to estimate an empirical relationship and degree of agreement between the TTO values of patients’ own health and their 15D scores.

Methods: A total of 863 hospital patients aged 18–93 years filled in the 15D questionnaire to establish their 15D score and valued their present health with TTO. Wilcoxon signed rank test, the Spearman rank correlation coefficient and Tobit models were used to analyze the relation between the 15D and TTO scores.

Results: The null hypothesis of no tendency for one set of scores to be higher or lower than the other set could not be rejected. Apart from dummies for few patients groups, no additional information to the 15D score was found that would have explained significantly the variance in the TTO valuations of patients’ own health. The agreement between these to sets of scores turned out quite good at the aggregate level.

Conclusions: To the extent that mean TTO valuations of patients own health are valid for QALY calculations as they at least theoretically should be, and if experience of health states to be valued counts, the 15D scores are also valid without any transformation in a large group of heterogeneous patients. However, in certain patient groups, the agreement was not as good as overall.

Professor Gabbay says he is dismayed that our article on the history of HTA in a recent special issue makes so little mention of the NHS HTA Programme, He calls this “a puzzling oversight,” which “would both surprise and disappoint the thousands . . . who have been involved in some way or another.” It was not our intention to underplay the role of the program, nor to disappoint the thousands of participants. Rather, there was a considerable amount of material to cover and a limited amount of space to do it in. Any history of HTA in the United Kingdom is inevitably a personal reflection, and it is understandable that Professor Gabbay's own account would put the program more center-stage, given his role as former director.

Background: Information retrieval (IR) in health technology assessment (HTA) calls for transparency and reproducibility, but common practice in the documentation and presentation of this process is inadequate in fulfilling this demand.

Objectives: Our objective is to promote good IR practice by presenting the conceptualization of retrieval and transcription readable to non-information specialists, and reporting of effectively processed search strategies.

Methods: We performed a comprehensive database search (04/2010) to synthesize the current state-of-the-art. We then developed graphical and tabular presentation methods and tested their feasibility on existing research questions and defined recommendations.

Results: No generally accepted standard of reporting of IR in HTA exists. We, therefore, developed templates for presenting the retrieval conceptualization, database selection, and additional hand-searching as well as for presenting search histories of complex and lengthy search strategies. No single template fits all conceptualizations, but some can be applied to most processes. Database interface providers report queries as entered, not as they are actually processed. In PubMed®, the huge difference between entered and processed query is shown in “Details.” Quality control and evaluation of search strategies using a validated tool such as the PRESS checklist is suboptimal when only entry-query based search histories are applied.

Conclusions: Moving toward an internationally accepted IR reporting standard calls for advances in common reporting practices. Comprehensive, process-based reporting and presentation would make IR more understandable to others than information specialists and facilitate quality control.

Paul Trueman and colleagues (3) have reported on an important issue. Several HTAs on the same topic have been published recently. They have examined four recent HTA reports on drug-eluting stents (DES), demonstrating varying methods and conclusions. All four HTAs included local registry data and economic evaluations in addition to analyses of published research. The authors concluded that the published evidence considered by most of the agencies had “only limited influence on the resulting recommendations.”

Objectives: The aim of this study was to assess systematically the scope of evidence and purposes for which evidence is used in decision-analytic models of cost-effectiveness and to assess the implications for search methods.

Methods: A content analysis of published reports of models was undertaken. Details of cited sources were extracted and categorized according to three dimensions; type of information provided by the evidence, type of source from which the evidence was drawn and type of modeling activity supported by the evidence. The analysis was used to generate a classification of evidence. Relationships within and between the categories within the classification were sought and the implications for searching considered.

Results: The classification generated fourteen types of information, seven types of sources of evidence and five modeling activities supported by evidence. A broad range of evidence was identified drawn from a diverse range of sources including both research-based and non–research-based sources. The use of evidence was not restricted to the population of model parameters but was used to inform the development of the modeling framework and to justify the analytical and methodological approach.

Conclusions: Decision-analytic models use evidence to support all aspects of model development. The classification of evidence defines in depth the role of evidence in modeling. It can be used to inform the systematic identification of evidence.

Objectives: Post-listing assessment of pharmaceuticals depends on national habits. In England, the assessment is based on estimates of cost per quality-adjusted life-year. These are made some considerable time after listing (negative list). In France, effectiveness, and then efficiency, is assessed immediately after listing (positive list). We propose a new formal method—the REAL method—that can help make early comparisons of the effectiveness of medical treatments.

Methods: Relative efficacies are first obtained from randomized controlled trials (RCTs). Members of the Transparency Committee (French National Authority for Health) are then consulted by questionnaire on the transposability of these results to real life. The RCT results and experts’ ratings are entered into an effect model to obtain estimates of relative effectiveness, using unidimensional scaling, and bootstrap procedures.

Results: Application of the REAL method to the example of a new drug to treat Parkinson's disease and three comparators used in the same indication provided graphs of the distributions of their relative efficacy and relative effectiveness. The new drug was found to provide no added value.

Conclusions: The REAL method is a rational, transparent, and practical procedure for comparing the effectiveness of pharmaceuticals in an immediate post-listing setting.

Objectives: The aim of this study was to analyze the information needs of Spanish health technology assessment (HTA) agencies and units to facilitate access to the resources they require to substantiate their reports.

Methods: A questionnaire was designed and distributed among HTA bodies to ascertain the actual situation of subscriptions to information resources and what information specialists from these bodies considered would be the ideal subscription situation. Their information needs were then studied, and the resources that best met these needs were put forward. Following this definition, a subscriptions policy was adopted with suppliers and publishers.

Results: The survey showed that HTA bodies share a minimum of core subscriptions that includes open sources (MEDLINE, DARE) and sources that the government subscribes to for the health community (ISI Web of Science, Cochrane Library Plus). There was no common approach to determining which databases to subscribe to (UpToDate, EMBASE, Ovid EBMR, CINAHL, or ECRI). After identifying the information needs, a list of resources was proposed that would best cover these needs and, of these, subscription to the following was proposed: Scopus, Ovid EBMR, Clinical Evidence, DynaMed, ECRI, and Hayes.

Conclusions: There are differences in the way that HTA agencies and units access the different resources of biomedical information. Combined subscription to several resources for documentation services was suggested as a way of resolving these differences.

This Theme Section of IJTAHC presents summaries of six policy briefs that address scaling up of artemisinin-based combination therapies (ACTs) in the treatment of uncomplicated falciparum malaria in Africa. The methods used to develop the policy briefs are described in the Section Editorial. Each summary assesses the problem, potential policy options to address the problem, and strategies for implementing those options.

EVIPNet (Evidence-Informed Policy Network) Africa—a network of World Health Organization (WHO)-sponsored knowledge-translation (KT) platforms in seven sub-Saharan African countries—was launched at a meeting in Brazzaville, Congo, in March 2006 (1;2). EVIPNet Africa can trace its origins to resolutions from both the Ministerial Summit on Health Research (November 2004) and the World Health Assembly (May 2005) (10;11), the spirit of which was re-affirmed at the Global Ministerial Forum on Research for Health (November 2008) (13). The World Health Assembly called for “establishing or strengthening mechanisms to transfer knowledge in support of evidence-based public health and health care delivery systems and evidence-based related policies” (10). EVIPNet Africa can trace its inspiration to a more local development: the preparatory work that led to the establishment of the East African Community–sponsored Regional East African Community Health (REACH) Policy initiative, a KT platform involving Kenya, Tanzania, and Uganda (and more recently Burundi and Rwanda as well). REACH Policy is now part of the EVIPNet Africa family.

Background: The Centre for Reviews and Dissemination (CRD) funded through the United Kingdom National Institute for Health Research undertakes systematic reviews evaluating the research evidence on health and public health questions of national and international importance. CRD is involved in methods research and produces internationally accepted guidelines for undertaking systematic reviews. A core product of the Centre are the CRD databases; a key resource for health professionals, policy makers, and researchers around the world. Research evidence evaluating the effects and cost-effectiveness of healthcare interventions is growing year on year, and can be difficult and time consuming to identify and appraise. The databases assist decision makers by systematically identifying and critically describing systematic reviews and economic evaluations, appraising their quality and highlighting their relative strengths and weaknesses; and providing a comprehensive listing of ongoing and published health technology assessments.

Methods and Results: This article briefly outlines the processes behind each of the three databases, gives details of the records, the information they contain and the value added by CRD. An overview of the new public interface for the CRD databases to be launched later this year is given. Improvements and innovations to supplement existing functions are listed, including enhanced and new search options, the addition of quick links to relevant material from within individual records, an integrated PubMed search and the ability to select personal preferences.

Conclusions: CRD's databases provide free access to an important knowledge base and are used widely to underpin evidence informed healthcare decisions in the United Kingdom and internationally.

Malaria is a major public health problem in Burkina Faso. Statistics from health facilities in 2006 show that 40.1 percent of medical consultations, 53.4 percent of hospital admissions, and 45.8 percent of deaths are malaria related (2). Malaria among children under 5 years of age accounted for 46 percent of all cases in 2004, 49 percent in 2005 and 48 percent in 2006. In the same age group, malaria was the cause of 66.4 percent of deaths in 2004, 62.0 percent in 2005 and 62.7 percent in 2006.

Malaria is the major cause of illness in Cameroon, responsible for 40 percent of medical consultations. For this reason, the Head of State along with his African Union peers in April 2000 and 2006 undertook to achieve universal access to malaria control interventions, including effective treatment (10;12). Uneven distribution of health services, especially in rural areas, and high poverty rates make health care and drugs inaccessible or unaffordable (14;16). Therefore, the World Health Organization recommends building comprehensive mechanisms grounded on relevant social and community organizations, including the private sector, to improve access to care for vulnerable populations (22;23). Accordingly, the strategic plan to fight malaria in Cameroon, endorsed by the National Committee to Roll Back Malaria, recommends home-based management of malaria (HMM) to improve access and reduce delays in treatment (12).

In the Central African Republic (CAR) malaria is a major public health problem and hampers socioeconomic development. It accounts for 40 percent of complaints and 10 percent of deaths in health facilities (15;17). Pregnant women, who make up 4 percent of the population, and children under 5 years of age, who represent 17.3 percent, are the groups most vulnerable to malaria owing to their low levels of immunity.